Hypercalcaemia secondary to hepatocellular carcinoma

Many syndromes reflecting impaired metabolism have been described in associ ation with primary neoplastic diseases. Hypercalcaemia secondary, to malign ancy without bone metastases and with normal parathyroid glands has been de scribed as "pseuclohyperparathyroidism". Differentiation from primary hyper parathyroidism is difficult and care should be taken to exclude an occult m alignancy prior to surgical exploration for a parathyroid adenoma. Hypercal caemia associated with hepatocellular carcinoma is not uncommon. Neverthele ss, we describe a rare case of coma with persistent hypercalcaemia in a cir rhotic patient not previously known to have hepatocellular carcinoma.